Related Experiment Video
Updated: Aug 29, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Safety and efficacy evaluation of clopidogrel compared to ticlopidine after stent implantation: an updated
Gianni Casella1, Filippo Ottani, Pier Camillo Pavesi
1Cardiology Division, Maggiore Hospital, Bologna, Italy. gcas@fastmail.it
Insights
Clopidogrel plus aspirin significantly reduces death and myocardial infarction after coronary stenting compared to ticlopidine. This combination therapy also demonstrates a superior safety profile, with fewer adverse side effects.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Aspirin plus ticlopidine is standard antithrombotic therapy post-coronary stenting.
- Ticlopidine has significant severe side effects.
- Clopidogrel, a safer alternative, has been introduced.
Purpose of the Study:
- To compare the clinical efficacy and safety of clopidogrel plus aspirin versus ticlopidine plus aspirin after coronary stenting.
- To update data through a formal meta-analysis.
Main Methods:
- Meta-analysis of ten studies including 11,688 patients.
- 30-day follow-up after successful coronary stenting.
- Primary endpoints: composite of death/non-fatal myocardial infarction (MI) and major adverse side effects.
Main Results:
- Clopidogrel plus aspirin showed reduced death/non-fatal MI (OR 0.63, p=0.003).
- A trend towards fewer major adverse cardiac events (OR 0.83, p=0.1) was observed.
- Clopidogrel significantly reduced major adverse side effects (OR 0.53, p<0.00001) and drug intolerance (OR 0.51, p<0.0001).
Conclusions:
- Clopidogrel plus aspirin demonstrates superior clinical efficacy in reducing death and non-fatal MI post-stenting.
- Clopidogrel offers a significantly better safety profile compared to ticlopidine.
- Findings confirm previous trial results on a larger scale.
Background:
Combination therapy with aspirin plus ticlopidine has become the reference antithrombotic therapy after coronary stenting. However despite its effectiveness, ticlopidine is associated with a significant incidence of severe side effects. Thus, clopidogrel, a ticlopidine analogue with an excellent safety profile, has been introduced in clinical practice. To date only a few, underpowered studies comparing the clinical efficacy of clopidogrel and aspirin versus standard combination therapy after coronary stenting have been performed and the odds ratios (OR) vary substantially among them. The purpose of the present investigation was to update the data regarding this issue by means of a formal meta-analysis.
Methods:
Ten studies were considered suitable for analysis. The OR were calculated for 30 days of follow-up in patients who had undergone successful coronary stenting. Primary endpoints were a composite of death and non-fatal myocardial infarction (MI) (efficacy endpoint) as well as a composite of major adverse side effects (safety endpoint) as considered in every single study. Secondary endpoints were a composite of major adverse cardiac events, according to single study definition, and individual cardiac events as well.
Results:
Overall, 11688 patients were included. At 30 days, the OR for death and non-fatal MI was 0.63 (95% confidence interval-CI 0.47 to 0.85, p = 0.003) in favor of patients treated with clopidogrel and aspirin. There was also a trend toward less major adverse cardiac events (OR 0.83, 95% CI 0.66 to 1.03, p = 0.1), less mortality (OR 0.70, 95% CI 0.40 to 1.25, p = 0.2), and less non-fatal MI (OR 0.76, 95% CI 0.54 to 1.07, p = 0.1). Furthermore, OR for major adverse side effects was 0.53 (95% CI 0.42 to 0.66, p < 0.00001) in favor of clopidogrel. Similarly, drug intolerance was significantly reduced by clopidogrel (OR 0.51, 95% CI 0.36 to 0.72, p < 0.0001). Fewer patients on clopidogrel developed neutropenia or thrombocytopenia (OR 0.58, 95% CI 0.18 to 1.81, p = 0.3), while the incidence of severe bleeding was similar in the two groups (OR 1.19, 95% CI 0.71 to 1.99, p = 0.5).
Conclusions:
The present meta-analysis demonstrates that clopidogrel reduces the 30-day combined endpoint of death and non-fatal MI, thereby showing a superior clinical efficacy compared to ticlopidine in patients who had undergone successful coronary stenting. A significantly better safety profile than ticlopidine was also reported, confirming on a larger scale the findings of randomized comparative trials.
